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Microbial considerations in genetically engineered mouse research.

Microbial infections have long been of concern to scientists using laboratory rodents because of their potential to confound and invalidate research. With the explosion of genetically engineered mice (GEM), new concerns over the impact of microbial agents have emerged because these rodents in many cases are more susceptible to disease than their inbred or outbred counterparts. Moreover, interaction between microbe and host and the resulting manifestation of disease conceivably differ between GEM and their inbred and outbred counterparts. As a result, infections may alter the GEM phenotype and confound interpretation of results and conclusions about mutated gene function. In addition, because GEM are expensive to produce and maintain, contamination by pathogens or opportunists has severe economic consequences. This review addresses how microbial infections may influence phenotype, how immunomodulation of the host as the result of induced mutations may modify host susceptibility to microbial infections, how novel host:microbe interactions have led to the development of new animal models for disease, how phenotype changes have led to the discovery of new pathogens, and new challenges associated with prevention and control of microbial infections in GEM. Although the focus is on naturally occurring infections, extensive literature on the use of GEM in studies of microbial pathogenesis also exists, and the reader is referred to this literature if microbial infection is a suspected culprit in phenotype alteration.

Animals↗

Diagnosis and pathophysiology of migraine.

Over the past 10 years there has been an explosion of knowledge about headache, particularly migraine. Fueled by new, highly effective therapeutic agents, vast resources have been invested in improving diagnostic accuracy and attempting to understand the mechanisms by which this symptom is generated. Public awareness has increased as has that of the medical community. Tools are now available to help diagnose particular types of headache and measure/monitor disability. Numerous pathophysiologic changes have been studied which may in turn increase the therapeutic armamentarium. With approximately 10% of the public suffering from migraine and with most of these cases remaining undiagnosed, it is likely that this segment of the healthcare market will continue to expand in the future.

Humans↗

Angiogenesis and Cancer Control: From Concept to Therapeutic Trial.

BACKGROUND: There is extraordinary interest in developing angiosuppressive agents for cancer treatment. Several new agents appear promising for the treatment of a variety of human cancers. Current concepts and new agents in clinical trials are the focus of this article. In particular, the introduction of a new treatment for human brain tumors is presented in detail, using an antiangiogenic agent, penicillamine, and depletion of an obligatory cofactor of angiogenesis, copper. METHODS: The explosive increase in literature on antiangiogenesis is reviewed using computerized search, findings presented at the recent national cancer and angiogenesis meetings. A specific protocol, NABTT 97-04, "Penicillamine and Copper Reduction for Newly Diagnosed Glioblastoma," is presented as an example of angiotherapeutic drug discovery. RESULTS: A number of promising molecular approaches are being introduced to suppress tumor angiogenesis. Major categories of angiogenesis antagonists include protease inhibitors, direct inhibitors of endothelial cell proliferation and migration, suppression of angiogenic growth factors, inhibition of endothelial-specific integrin/ survival signaling, chelators of copper, and inhibitors with specific other mechanisms. The preliminary results of early trials offer a glimpse into how antiangiogenesis therapy will be integrated into future care of the patient with cancer. CONCLUSIONS: Thirty-five antiangiogenesis therapies are currently being evaluated in clinical trials. As we learn more about the fundamental mechanisms of angiogenesis, eg, the role of copper in growth factor activation, effective methods of cancer control will be implemented.

Journal Article↗

Nosocomial viral respiratory infections.

Nosocomial infections with respiratory tract viruses, particularly influenza and respiratory syncytial viruses, account for the majority of serious nosocomial viral disease. Chronically ill, immunocompromised, elderly, and very young hosts are especially vulnerable to potentially life-threatening involvement of the lower respiratory tract. Effective preventive strategies are based upon early accurate viral diagnosis and an appreciation of the epidemiology and mechanisms of transmission for each viral agent. Influenza viruses spread via airborne dispersion of small particle aerosols, resulting in explosive outbreaks; control measures emphasize immunization and chemoprophylaxis of susceptible patients and personnel, and isolation of those already infected. Transmission of respiratory syncytial virus, in contrast, seems to require closer contact, with virus passed on hands, fomites, or in large droplets inoculated into the eyes and nose at close range. Strategies for control of nosocomial respiratory syncytial virus are designed to interrupt hand carriage and inoculation of virus onto mucous membranes.

Aged↗

DNA damage, gene expression, growth arrest and cell death.

The sequence of biochemical and molecular events that mediate growth arrest and cell death in tumor cells exposed to agents that induce DNA damage is poorly defined. This commentary exploits the recent explosion of information regarding oncogenes, tumor suppressor genes, and cell-cycle regulatory genes to develop a model for growth arrest/cell death. The model focuses on changes in the expression of these genes, in the level and phosphorylation of their protein products, and in the interaction(s) between these proteins. It is recognized that such a model is, of necessity, incomplete, since new gene functions associated with the cellular response to DNA damage will continuously be uncovered; in addition, the proposed sequence of events will likely require modification as the relationships between the functions of the discrete gene products are clarified. Nevertheless, it is hoped that this commentary will provide a conceptual framework within which to fit currently available information as well as future findings relating to the expression and function of DNA-damage-responsive genes, and that the sections of the model that are incomplete will provide a springboard for the development of research approaches designed to answer specific questions regarding the nature of the cellular response to DNA damage.

Animals↗

Biological warfare--an emerging threat.

As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.

Biological Warfare↗

Versatile new ion source for the analysis of materials in open air under ambient conditions.

A new ion source has been developed for rapid, noncontact analysis of materials at ambient pressure and at ground potential. The new source, termed DART (for "Direct Analysis in Real Time"), is based on the reactions of electronic or vibronic excited-state species with reagent molecules and polar or nonpolar analytes. DART has been installed on a high-resolution time-of-flight mass spectrometer (TOFMS) that provides improved selectivity and accurate elemental composition assignment through exact mass measurements. Although DART has been applied to the analysis of gases, liquids, and solids, a unique application is the direct detection of chemicals on surfaces without requiring sample preparation, such as wiping or solvent extraction. DART has demonstrated success in sampling hundreds of chemicals, including chemical agents and their signatures, pharmaceutics, metabolites, peptides and oligosaccharides, synthetic organics, organometallics, drugs of abuse, explosives, and toxic industrial chemicals. These species were detected on various surfaces, such as concrete, asphalt, human skin, currency, airline boarding passes, business cards, fruits, vegetables, spices, beverages, body fluids, horticultural leaves, cocktail glasses, and clothing. DART employs no radioactive components and is more versatile than devices using radioisotope-based ionization. Because its response is instantaneous, DART provides real-time information, a critical requirement for screening or high throughput.

Air↗

Acute gastroenteritis among schoolchildren associated with reovirus-like agent.

During early summer 1975 and spring 1976, outbreaks of acute gastroenteritis were reported from primary schools and other institutions in several districts of Japan. Outbreaks occurred in an explosive manner resembling mass food poisoning from a school lunch. The majority of patients were in the age group 6-14 years. Clinical features were generally mild, consisting of vomiting and/or diarrhea, often with low-grade fever. Reovirus-like agents in the feces were found in 27 (44%) of 62 patients. The virus found in feces of schoolchildren with acute gastroenteritis (SCGV) was related morphologically as well as serologically, not only to the agent found in infantile gastroenteritis (IGV), but also to neonatal calf diarrhea virus (NCDV). A slight difference in antigenicity between SCGV and IGV as suggested by cross complement fixation (CF) remains to be elucidated. About one-half of paired sera from 54 patients showed a significant rise in CF antibody against SCGV and/or NCDV. The pattern of neutralizing (NT) antibody against NCDV in patients' sera was similar to that of CF antibody. Most children studied had a titer of 1:4 or greater of CF and/or NT antibodies to SCGV and NCDV in acute sera. The relationship between acute gastroenteritis associated with reovirus-like agent in infants and that in schoolchildren is discussed.

Acute Disease↗

[An explosive outbreak of respiratory streptococcal infection with a droplet transmission mechanism].

The data obtained in the study of an explosive outbreak of acute respiratory diseases, tonsillitis and scarlet fever in one of schools in Moscow have made it possible to exclude the alimentary mechanism of its development and to demonstrate the role of the droplet mechanism of transmission in the appearance of its outbreak. The epidemiological analysis of the outbreak has permitted the formulation of the hypothesis on the conditions of the formation and spread of the epidemic variant of the infective agent; this hypothesis corresponds to the available data in literature on the qualitative changes of the infective agent in the course of the epidemic process. The study has shown that the prophylaxis of the explosive outbreaks of respiratory streptococcal infections must be ensured by the system of epidemiological surveillance with timely intervention into the epidemiological process at its early stages.

Adolescent↗

New phase I trial methodology.

Phase I trial design is constantly evolving to adapt to deficiencies in traditional methods and to accommodate newer rationally designed agents. This article discusses some of the important aspects of the design of phase I studies with particular reference to identifying new methods of safer but rapid dose escalation and reproducible end points such as maximum tolerated dose and recommended phase II dose. Given the explosion of rationally designed drugs capable of pathway specific inhibition, we also discuss potential strategies in designing trials with these agents. It is hoped that future strategies incorporate the existing methodologies with newer dose titration examples to complete phase I trials in a rapid and timely fashion.

Clinical Trials, Phase I as Topic↗

Immunotherapy for sepsis.

In recent years, an improved understanding of the pathogenesis of sepsis, along with an explosion in the biotechnology industry, has led to the development of a variety of agents with potential to interdict the pathogenesis of sepsis at many points. This article reviews the rationale, efficacy and shortcomings of these immunotherapeutic agents as they relate to the management of human septic shock.

Animals↗

Conclusions and comments. Xth International Symposium on Cholinergic Mechanisms.

Ancient medicine men of Egypt and Arabia employed, under another name, the cholinergic agents, as did the hunters, warriors and shamans of Africa and South America. An explosion of cholinergic science occurred in the last and the current century, and the ISCMs witnessed and catalyzed this progress. The Xth ISCM emphasized the molecular characteristics of the receptors, cholinesterase and of the system engaged in liberation of Ach.

Acetylcholine↗

Treatment of the mangled lower extremity after a terrorist blast injury.

Terrorist bombings, with resultant blast injuries, have been increasing in frequency during the past 30 years. Injury to the musculoskeletal system is common in victims who survive such attacks. Substantial injury to the limbs may occur through several different mechanisms, each of which may affect prognosis and alter the treatment algorithm. An analysis of the available literature on terrorism and blast events revealed that resource use of the treating medical facility is high during the initial hours after a blast attack, but usually is manageable. A resource management protocol was developed to organize the treatment of limb salvage into four phases. This management protocol may improve the medical facility's ability to manage system resources while treating patients with severe blast injuries. The decision of whether to salvage or proceed with limb amputation is one of the most difficult in orthopaedic trauma. A basic education in the mechanisms of blast damage, a methodical approach to resuscitation, and mangled extremity treatment, likely can improve surgical success.

Amputation, Surgical↗

Military perspective on the civilian response to the London bombings July 2005.

With the break up of the Warsaw Pact and changing global relations, current military deployments are becoming smaller and more expeditionary (e.g. Afghanistan, East Timor and Sierra Leone). During the Cold War, the use of weapons of mass effect was highly likely to have been seen on the battlefield. Ironically, the proliferation of CBRN agents and the knowledge of their application, as well as the manufacture of improvised explosive devices, have lead to the targeting of civilian populations by extremist groups. One of the benefits of military clinicians embedded in NHS hospital trusts, as well as a strong reservist cadre, is a greater understanding of the implications and management of asymmetric attacks against the U.K. The experience and skills of military clinicians may be of benefit to NHS trusts while this type of threat exists. Military clinicians are also likely to benefit from the experience that they get in certain NHS posts that provide skills that are readily transferable to military medicine. The events of 7th July highlighted the dynamic use of deployable medical resources and a rapid return to normal service provision. This type of 'Health Resilience' can only be achieved with a combination of effective emergency planning, on scene clinical risk management and clinical leadership.

Communication↗

Antifungal activity from Ocimum gratissimum L. towards Cryptococcus neoformans.

Cryptococcal infection had an increased incidence in last years due to the explosion of acquired immune deficiency syndrome epidemic and by using new and effective immunosuppressive agents. The currently antifungal therapies used such as amphotericin B, fluconazole, and itraconazole have certain limitations due to side effects and emergence of resistant strains. So, a permanent search to find new drugs for cryptococcosis treatment is essential. Ocimum gratissimum, plant known as alfavaca (Labiatae family), has been reported earlier with in vitro activity against some bacteria and dermatophytes. In our work, we study the in vitro activity of the ethanolic crude extract, ethyl acetate, hexane, and chloroformic fractions, essential oil, and eugenol of O. gratissimum using an agar dilution susceptibility method towards 25 isolates of Cryptococcus neoformans. All the extracts of O. gratissimum studied showed activity in vitro towards C. neoformans. Based on the minimal inhibitory concentration values the most significant results were obtained with chloroformic fraction and eugenol. It was observed that chloroformic fraction inhibited 23 isolates (92%) of C. neoformans at a concentration of 62.5 microg/ml and eugenol inhibited 4 isolates (16%) at a concentration of 0.9 microg/ml. This screening may be the basis for the study of O. gratissimum as a possible antifungal agent.

Antifungal Agents↗

Helicobacter pylori: fact or fiction?

The recent isolation and classification of the spiral gastric bacteria Helicobacter pylori has led to an explosion of worldwide research. The data strongly suggest that H. pylori is the causative agent for type-B active chronic gastritis. The role of H. pylori in duodenal ulcer awaits clarification, and, more importantly, potential treatment regimens need clear documentation and further detailed research. The past decade has revealed many intriguing facts about H. pylori infection. If, during the 1990s, eradication of H. pylori by means of appropriate and safe medication can lead to the control and prevention of gastroduodenal disease, then major clinical and economic benefits can be anticipated.

Anti-Ulcer Agents↗